Federal (United States) · Agency guidance
Chapter 8
78 sections
78 sections
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.1Appeal of Denials
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2Overpayment Procedures
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.1Overpayment Assessment Procedures
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.1.1Definition of Overpayment Assessment Terms
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.2Assessing Overpayment When Review Was Based on Statistical
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3Assessing Overpayment or Potential Overpayment When Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.1Contractor Activities to Support Assessing Overpayment
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.2Conduct of Expanded Review Based on Statistical Sampling
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3Reserved for Future Use
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.1Background on Consent Settlement
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.2Opportunity to Submit Additional Information Before
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.3Consent Settlement Offer
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.4Option 1 - Election to Proceed to Statistical Sampling for
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.5Option 2 - Acceptance of Consent Settlement Offer
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3.3.6Consent Settlement Budget and Performance Requirements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.4Coordination With Audit and Reimbursement Staff
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3Suspension of Payment
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.1When Suspension of Payment May Be Used
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.1.1Credible Allegation of Fraud Exists Against a Provider - Fraud
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.1.2Reliable Information that an Overpayment Exists - General
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.1.3Reliable Information that the Payments to Be Made May Not
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.1.4Provider Fails to Furnish Records and Other Requested
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2Procedures for Implementing a Payment Suspension
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.1CMS Approval
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2The Notices Involving Payment Suspensions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2.1Issuing a Prior Notice versus Issuing a Concurrent Notice
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2.2Content of Payment Suspension Notice
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2.3Shortening the Notice Period for Cause
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2.4Mailing the Notice to the Provider
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.2.5Opportunity for Rebuttal
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.3Claims Review During the Payment Suspension Period
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.3.1Claims Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.3.2Case Development – Program Integrity
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.4Duration of the Payment Suspension
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.5Terminating the Payment Suspension
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.6Disposition of the Withheld Funds
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.2.7Contractor Suspects Additional Improper Claims
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.3Suspension Process for Multi-Region Issues (National Payment
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.3.1DME Payment Suspensions (MACs and UPICs)
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.3.3.2Non-DME National Payment Suspensions (MACs and UPICs)
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4Use of Statistical Sampling for Overpayment Estimation
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1Introduction
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.1General Purpose
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.2The Purpose of Statistical Sampling
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.3Steps for Conducting Statistical Sampling
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.4Determining When Statistical Sampling May Be Used
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.5Consultation With a Statistical Expert
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.6Use of Other Sampling Methodologies
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.2Probability Sampling
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3Selection of Period to be Reviewed and Composition of Universe
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3.1Selection of Period for Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3.2Defining the Universe, the Sampling Unit, and the Sampling
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3.2.1Composition of the Universe
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3.2.2The Sampling Unit
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.3.2.3The Sampling Frame
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4Sample Selection
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.1Sampling Methodology
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.2Random Number Selection
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.3Determining Sample Size
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.4Documentation of Sampling Methodology
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.4.1Documentation of Universe and Sampling Frame
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.4.2Reserved for Future Use
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.4.3Worksheets
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.4.4Overpayment/Underpayment Worksheets
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.4.5Maintenance of Documentation
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.5Calculating the Estimated Overpayment
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6Actions to be Performed Following Selection of Provider or
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6.1Notification of Provider or Supplier of the Review and
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6.1.1Written Notification of Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6.1.2Determining Review Site
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6.2Meetings to Start and End the Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.6.3Conducting the Review
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.7Overpayment Recovery
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.7.1Recovery From Provider or Supplier
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.8Corrective Actions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.9Changes Resulting From Appeals
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.9.1Sampling Methodology Overturned
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.9.2Revised Initial Determination